I've spent years exploring health, mental health, and science as a journalist based on the Left Coast. I covered west coast biotech and science for Bloomberg News and contributed to dozens of publications including Bloomberg Business Week, Mother Jones, Salon, Health magazine, Reader’s Digest, Parenting, and the Los Angeles Times. I’m interested in how and why the wealthiest country in the world has such an irrational healthcare system that develops brilliant new therapies while overtreating many and underserving even more. I'm also deeply interested in efforts to make our communities healthier by ensuring that everyone has access to the things that foster good health -- good food, safety and the chance to be physically, politically and socially active.

Finding The Way To Wellville: Small Cities Compete To Get Healthier In Esther Dyson's Latest Venture

Esther Dyson and her team are looking for a few good towns—five, to be precise—that want to take part in a grand experiment. Dyson, a tech investor named by Time magazine as one of the 10 most influential women in technology, wants to enlist small cities in a friendly competition to figure out how communities can become healthier places inhabited by healthier residents.

Here’s the idea: After going through a competitive selection process, five small cities or counties—each with a population of 100,000 or less—will be chosen to spend the next five years finding “The Way to Wellville,” as Dyson and her partners call the contest. So far, 10 finalists have been chosen, places like Scranton, Pennsylvania; Greater Muskegon, Michigan; Spartanburg, South Carolina; and Lake County, California. (A map showing the full list is here.)

The Way to Wellville tour stopped July 22 in Clatsop County, Oregon, where Clatsop Community Action’s food bank operates the community garden seen in the background. Last year, the community garden harvested 6,000 pounds of fresh produce that was distributed to hungry people in the area.

To run the challenge, Dyson created a small organization with the catchy, if slightly alarming, acronym of HICCup. The Health Initiative Coordinating Council, its full name, will assist the winning contestants in their journey to Wellville. Dyson will help bankroll the effort—she’s put in about $200,000 so far—and is part of the selection group choosing the final five. They’re now in the midst of a 10-city tour visiting each of the finalists and plan to announce the winners in mid-August.

Dyson’s team will help the chosen five raise money and provide an expert “navigator” to assist each town as they build a locallocal coalition by bringing many parties together—community advocates, health policy wonks, medical providers, local business leaders, finance experts—to develop and execute a health-improvement plan.

The contest will turn the five chosen communities into real-world, small-town laboratories. The hope is that by focusing on community-wide prevention and wellness efforts, each town will achieve real gains on a series of metrics that measure the health of the community and its people. Several of the 10 finalists have previous experience developing local health coalitions in conjunction with federal or private prevention grants. Overall metrics will be established at the start of the project for all five, with one individualized “wild card” metric for each community.

When it’s all over, Dyson told me, “I hope American health”—and not just the healthcare system—“will be changed. I hope there will be a visible impact that inspires people and actual, useful scientific data” that can be broadly shared.

Carrot harvest day at the community garden.

The project’s idea and goals are solidly in the tradition of place-based efforts to improve local health pioneered by the Healthy Communities movement when it started some 25 years ago in Boston, Colorado, South Carolina and 20 California cities. Those efforts, which continue with support of funders like the Robert Wood Johnson Foundation and Convergence Partnership, focus on the links between the health of a community and its environment—including transportation, land use and access to healthy food and activity. Community Transformation Grants from the Centers for Disease Control and Prevention have helped local areas pursue the same kinds of local change and improvement since 2010. In fact, several of the 10 Wellville finalist cities received support from this federal program and a predecessor.

Dyson’s innovation is to take a more entrepreneurial approach that incorporates new technology and encourages collaboration with investors, as well as philanthropists and community stakeholders. For her, the concept was inspired by an idea she once heard floated to use small towns as laboratories for health innovation and improvement. Since it never came to pass, she decided—and publicly announced—she would do it herself.

“Then I had to figure out what I had gotten myself into,” she laughs. She convened a series of brainstorming meetings to develop the concept. In the process, she met and hired Rick Brush, a former CignaCigna health insurance executive who has spent the last several years looking at ways to create market-based incentives that lead to improvements in the health not just of individuals, but of whole communities. As HICCup’s CEO, part of his job will be to help the communities work with health insurers and investors who hope to generate revenue by reducing spending on healthcare costs.

“Our DNA is connected to the market-based approach.” Brush told me. “The business models that demonstrate an impact on producing better health at a community level are the ones that are going to succeed.”

The project has moved rapidly since the call for applications was issued April 10. Forty-two applicants submitted by the May 23 deadline; since then the six-member selection committee has narrowed the pool to 10 finalists. The five winners will be selected in mid-August after site visits to the final candidates that are now underway.

The contest will raise help each town raise its visibility, helping attract publicity and financial support. Brush estimates each town will need to raise $15 million to $50 million in cash and in-kind contributions to fund community transformation efforts. HICCup’s navigators will help them apply best practices in the areas of prevention and health-improvement and make use of cutting-edge technology.

The HICCup team will also develop three networks of partners. The first will be a “health mart” to include startups and companies like IBMIBM that are developing health apps and IT systems as well as national retailers like Walmart and Walgreens that want to “assess whether they can create a market for healthy foods,” says Brush.

A second network will help the towns attract capital and develop new kinds of sustainable financing that can pay for health-improvement efforts over the five years of the contest and beyond. One approach is social impact bonds—financing vehicles that raise money from private investors to address conditions like moldy homes or polluted air that perpetuate asthma. If the people’s health improves, reducing healthcare costs, the investors get some of the savings back as profit.

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